İNMELİ HASTALARDA ÜST EKSTREMİTE SPASTİSİTESİ ÜZERİNE BOTULİNUM TOKSİN A ENJEKSİYONLARININ ETKİNLİĞİ

Öz

Bu çalışma inme sonucu üst ekstremitede spastisite gelişen hastalarda botulinum toksin A BTX-A uygulamalarının yetersizlik, fonksiyonel durum ve yaşam kalitesi üzerine etkilerini değerlendirmek amacıyla planlanmıştır. Bu açık etiketli kontrolsüz çalışmaya üst ekstremitede spastisite gelişen 20 inmeli hasta alındı. Modifiye Ashworth Skalası’na MAS göre yapılan değerlendirmede grade 2 ve üzerinde spastisite olan kaslara BTX-A uygulandı. Değerlendirmeler enjeksiyon öncesi ve sonrası 4. ve 24. haftalarda yapıldı. Eklem hareket açıklığı EHA , ağrı ve spastisite sırasıyla goniometri, VAS, MAS ve doktorun spastisitedeki değişimi global değerlendirilmesi DGD ile değerlendirildi. Fonksiyonel durum Fonksiyonel Bağımsızlık Ölçeği FBÖ ve yaşam kalitesi İnmeye Özgü Yaşam Kalitesi Skalası ile değerlendirildi. Hastaların yaş ortalamaları 59.1±7.4 yıldı. Enjeksiyon sonrası iki kontrolde de omuz ağrısı ve omuz EHA’larında anlamlı düzelme p

Anahtar Kelimeler

• İnme,spastisite,botulinum toksin

EFFICACY OF BOTULINUM TOXIN A INJECTIONS ON UPPER LIMB SPASTICITY IN PATIENTS WITH STROKE

Abstract

This study was planned to evaluate the effect of botulinum toxin A BTX-A injection on impairment, functional disability and quality of life in patients with upper limb spasticity after stroke. Twenty stroke patients with upper limb spasticity attended this open-label, noncontrolled trial. BTX-A was applied to muscles that have a grade two or more spasticity according to the Modified Ashworth Scale MAS . Assessments were made at baseline and at weeks 4 and 24 after injection. Range of motion ROM , pain, and spasticity were evaluated by goniometer, VAS, MAS, and physician global assessment of change GAC , respectively. Functional status was evaluated by Functional Independence Measure FIM and the quality of life was evaluated by Stroke Specific Quality of Life Scale. The mean age of the patients was 59.1±7.4 years. It was observed that a significant improvement in shoulder pain and ROM of shoulder p

Keywords

• Stroke,spasticity,botulinum toxin

References

1. Brandstater ME (Çeviri: Gök H.). İnme Rehabilitasyonu. In: Delisa JA (Çeviri Editörü: Arasıl T). Fiziksel Tıp ve Rehabilitasyon İlkeler ve Uygulamalar. İstanbul: Güneş Tıp Kitabevleri; 2007: p. 1656-1676. 2.
2. Dalyan Aras M, Çakçı A. İnme rehabilitasyonu. In: Oğuz H, Dursun E, Dursun N. Tıbbi Rehabilitasyon. İstanbul: Nobel Tıp Kitabevi; 2004: p. 589-617. 3.
3. Yablon SA, Brashear A, Gordon MF, Elovic EP, Turkel CC, Daggett S, et al. Formation of neutralizing antibodies in patients receiving botulinum toxin type A for treatment of poststroke spasticity: a pooled-data analysis of three clinical trials. Clin Ther 2007;29:683-90. 4. Gallichio JE.
4. Pharmacologic management of spasticity following stroke. Phys Ther 2004;84:973-81.
5. Chou R, Peterson K, Helfand M. Comparative efficacy and safety of skeletal muscle relaxants for spasticity and systematic review. J Pain Symptom Manage 2004;28:140-75. a 6.
6. Das TK, Park DM. Effect of treatment with botulinum toxin on Postgrad Med J 1989;65:208-10. spasticity. 7.
7. Karaçam M, Selçuki D. İnme sonrası gelişen spastisite tedavisinde botulinum toksin A intramüsküler enjeksiyonu etkinliği. Turk Norol Derg 2010;16:133- 40. 8.
8. Ozcakir S, Sivrioglu K. Botulinum toxin in poststroke spasticity. Clin Med Res 2007;5:132-8. 9.

9. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle 1987;67:206-7. Phys Ther 10.
10. Wang HC, Hsieh LF, Chi WC, et al. Effect of intramusculer botulinum toxin injection on upper limb spasticity in stroke patients. Am J. Phys. Med. Rehabil 2002; 81; 272-8. 11.
11. Kucukdeveci AA, Yavuzer G, Elhan AH, Sonel B, Tennant A. Adaptationof the Functional Independence Measure for use in Turkey.Clin Rehabil 2001; 15: 311–9. 12.
12. Williams LS, Weinberger M, Harris LE, Clark DO, Biller J. Development of a stroke-specific quality of life scale. Stroke 1999; 30(7): 1362-9. 13.
13. Bhakta BB, Cozens JA, Bamford JM, Chamberlain MA. Use of botulinum toxin in stroke patients with severe upper limb spasticity. J Neurol Neurosurg Psychiatry 1996 ;61:30-5.
14. Simpson DM, Alexander DN, O'Brien CF, Tagliati M, Aswad AS, Leon JM, et al. Botulinum toxin type A in the treatment of randomized, controlled 1996;46:1306-10. spasticity: a double-blind, placebo- Neurology trial. 15.
15. Brashear A, Gordon MF, Elovic E, Kassicieh VD, Marciniak C, Do M, et al. Intramuscular injection of botulinum toxin for the treatment of wrist and finger spasticity after a stroke. N Engl J Med 2002;347:395-400. 16.
16. Bakheit AM, Thilmann AF, Ward AB, Poewe W, Wissel J, Muller J, et al. A randomized, controlled, dose-ranging
17. compare the efficacy and safety of three doses of botulinum toxin type A (Dysport) with placebo in upper limb spasticity after stroke. Stroke 2000 Oct;31:2402-6. placebo- study to 17.
18. Bakheit AM, Pittock S, Moore AP, Wurker M, Otto S, Erbguth F, et al. A randomized
19. controlled study of the efficacy and safety of botulinum toxin type A in upper limb spasticity in patients with stroke. Eur J Neurol 2001;8:559-65. placebo- 18.
20. Brashear A, McAfee AL, Kuhn ER, Fyffe J. Botulinum toxin type B in upper- limb poststroke spasticity: a double- blind, placebo-controlled trial. Arch Phys Med Rehabil 2004;85:705-9.
21. Smith SJ, Ellis E, White S, Moore AP. A double-blind placebo-controlled study of botulinum toxin in upper limb spasticity after stroke or head injury. Clin Rehabil 2000;14:5-13. 20.
22. Francis HP, Wade DT, Turner-Stokes L, Kingswell RS, Dott CS, Coxon EA. Does reducing spasticity translate into functional benefit? An exploratory meta- analysis. J Neurol Neurosurg Psychiatry 2004;75:1547-51.
23. Atalay Şimşir N, Akkaya N, Özlü A, Şahin F. Hemipleji sonrası gelişen spastisitede botulinum toksin A’nın etkinliği. Anatol J Clin Investig 2012;6:92-6. 22.
24. Koçak FA, Aras M, Köseoğlu FB. İnmeli spastisitesinin botulinum toksin tip A ile tedavisi. FTR Bil Der 2014; 17: 24-32. 23.
25. Dressler D, Saberi FA, Barbosa ER. Botulinum toxin: mechanisms of action. Arq Neuropsiquiatr 2005;63:180-5. 24.
26. Marco E, Duarte E, Vila J, Tejero M, Guillen A, Boza R, et al. Is botulinum toxin type A effective in the treatment of spastic shoulder pain in patients after stroke? A double-blind randomized clinical trial. J Rehabil Med 2007;39:440- 7.
27. Memin B, Pollak P, Hommel M, Pemet J. Treatment of spasticity with botulinum toxin. Rev Neurol (Paris) 1992; 148(3): 212-14. 26.
28. Gündüz B, Atamaz F. İnme ve hayat kalitesi: Türk Fiz Tıp Rehab Derg 2006; 52 (Özel Ek B): B45-B49. 27.
29. Welmer AK, von Arbin M, Widen Holmqvist L, Sommerfeld DK. Spasticity and its association with functioning and health-related quality of life 18 months after 2006;21:247-53. Cerebrovasc
30. Dis Yazının alınma tarihi:05.02.2014
31. Kabül tarihi:15.02.2014
32. Online basım:15.02.2014